Kelly Koerner has generously contributed the inaugural TADBiT blog for the new triangleareadbt.com website. You may know of Kelly from her immensely helpful book, Doing Dialectical Behavior Therapy: A Practical Guide. We are pleased to share with you some her current thinking on the role of deliberate practice for therapists to become more effective in their application of DBT.

Why Deliberate Practice? Getting Off the Amateur Plateau

I love this graphic by Kathy Sierra

Often performance improves but then levels off, stranding us on the amateur plateau. Our performance plateaus because we become "good enough" at what we do to solve our immediate problem. For example, early on through effort, trial and error, and supervisor feedback we develop enough skill to deal with many situational demands (e.g., early on we learned a way to do an intake session or suggest sleep hygiene ideas or assess suicide risk that seemed good enough to get the job done). Then these ways of doing things became increasingly automatic-it's easy and efficient to do an intake or respond to a clinical problem the way we have always done it. From the point when we reach automaticity of a skill, experience alone does not produce performance improvements.

Instead, part of what's needed to get off the amateur plateau and move toward true expertise is a process called deliberate practice. Deliberate practice is when you choose to practice what you are not good at with "sustained, mindful efforts to develop the full range of abilities that success requires." (Gawande, A. Personal Best. The New Yorker, 2011). Like the way a musician might rehearse a difficult passage of music phrase by phrase or an athlete might drill to improve a small but key move.

Deliberate practice with feedback is the way to build real skill as a therapist. It’s about breaking a complicated skill into pieces, practicing, getting feedback, and trying again.

Try a Deliberate Practice Exercise. Here’s one (modify to suit you).

The demands and pressures of a normal day often make us begin interactions off center, tight and task focused, irritable or hassled.

Think for a moment: for you, what would an A+ look like (the stance you most hope for that is centered, open, friendly)?

Pick one person, one day, or all week with everyone that you will practice, trying for your A+ version of centered, open, friendly as you start an interaction.

Set a reminder (e.g., a note to yourself to help you remember to practice).

Then practice.

After each practice, give yourself a quick letter grade to mark how successful you were at starting the interaction from a centered, open, and friendly stance. (This can be just a mental note, "OK that was a C. To be an A next time, I would...")

For example, I will practice with my 13 y.o. daughter. All weekend, each time I begin an interaction with her, I’m going to say her name (in my mind) while I smile and take a deep breath. That would be an ‘A’ for me. A C-, for example, would be me saying a friendly ‘hey’ while I keep typing on my computer. Got the idea? Don’t fret about getting a perfect practice. Any step, however small, to play with this idea will be great.

Design Your Own Deliberate Practice Exercise. This simple sequence can be used to improve any skill you have as a therapist. Choose an area to improve. What would an “A” look like? Identify and then use a repeating practice situation, trying to hit your target. Then each time reflect: how’d I do? What’s one thing to improve next time?

Taking the expertise research literature seriously leads to a different approach to teaching and learning as therapists. This motivates our intent at PracticeGround to be shoulder-to-shoulder with colleagues for the long haul, to work where things are hard, to build expertise that improves client outcomes.

What might it look like for you to move off the plateau and into a mindful effort to develop your full range of abilities as a therapist?

* * *

Kelly Koerner, Ph.D., is Creative Director and CEO of the Evidence-Based Practice Institute, where she explores how technology can scale learning and collaboration so practitioners get better clinical outcomes. More information at www.practiceground.org

She is a clinical psychologist and an expert clinician, clinical supervisor and trainer in Dialectical Behavior Therapy (DBT). She received her Ph.D. from the University of Washington and has specialized training in a number of evidence based treatments. She has served as: Director of Training for Marsha Linehan’s research investigating the efficacy of DBT for suicidal and drug abusing individuals with borderline personality disorder; Creative Director at Behavioral Tech Research where she developed e-learning and other technology based methods to disseminate evidence-based practices; and co-founder and first CEO of Behavioral Tech, a company that provides training in DBT.